Sedentary Work Exerting up to 10 pounds (4.5 kg) of force occasionally and/or a negligible amount of force frequently or constantly to lift, carry, push, pull, or otherwise move objects, including the human body. Sedentary work involves sitting most of the time, but may involve walking or standing for brief periods of time. Jobs are sedentary if walking and standing are required only occasionally and other sedentary criteria are met.

Light Work Exerting up to 20 pounds (9.1 kg) of force occasionally and/or up to 10 pounds (4.5 kg) of force frequently, and/or negligible amount of force constantly to move objects. Physical demand requirements are in excess of those for Sedentary Work. Light Work usually requires walking or standing to a significant degree. However, if the use of the arm and/or leg controls requires exertion of forces greater than that for Sedentary Work and the worker sits most the time, the job is rated Light Work.

Medium Work Exerting up to 50 (22.7 kg) pounds of force occasionally, and/or up to 25 pounds (11.3 kg) of force frequently, and/or up to 10 pounds (4.5 kg) of forces constantly to move objects.

Heavy Work Exerting up to 100 pounds (45.4 kg) of force occasionally, and/or up to 50 pounds (22.7 kg) of force frequently, and/or in excess of 20 pounds (9.1 kg) of force constantly to move objects.

Very Heavy Work Exerting in excess of 100 pounds (45.4 kg) of force occasionally, and/or in excess of 50 pounds (22.7 kg) of force frequently, and/or in excess of 20 pounds (9.1 kg) of force constantly to move objects.

Job Classification

In most duration tables, five job classifications are displayed. These job classifications are based on the amount of physical effort required to perform the work. The classifications correspond to the Strength Factor classifications described in the United States Department of Labor's Dictionary of Occupational Titles. The following definitions are quoted directly from that publication.

Sedentary Work Exerting up to 10 pounds (4.5 kg) of force occasionally and/or a negligible amount of force frequently or constantly to lift, carry, push, pull, or otherwise move objects, including the human body. Sedentary work involves sitting most of the time, but may involve walking or standing for brief periods of time. Jobs are sedentary if walking and standing are required only occasionally and other sedentary criteria are met.

Light Work Exerting up to 20 pounds (9.1 kg) of force occasionally and/or up to 10 pounds (4.5 kg) of force frequently, and/or negligible amount of force constantly to move objects. Physical demand requirements are in excess of those for Sedentary Work. Light Work usually requires walking or standing to a significant degree. However, if the use of the arm and/or leg controls requires exertion of forces greater than that for Sedentary Work and the worker sits most the time, the job is rated Light Work.

Medium Work Exerting up to 50 (22.7 kg) pounds of force occasionally, and/or up to 25 pounds (11.3 kg) of force frequently, and/or up to 10 pounds (4.5 kg) of forces constantly to move objects.

Heavy Work Exerting up to 100 pounds (45.4 kg) of force occasionally, and/or up to 50 pounds (22.7 kg) of force frequently, and/or in excess of 20 pounds (9.1 kg) of force constantly to move objects.

Very Heavy Work Exerting in excess of 100 pounds (45.4 kg) of force occasionally, and/or in excess of 50 pounds (22.7 kg) of force frequently, and/or in excess of 20 pounds (9.1 kg) of force constantly to move objects.

Bipolar Affective Disorder, Single Manic Episode

Medical Codes

ICD-9-CM:

296.00 -

Bipolar I Disorder, Single Manic Episode; Unspecified

296.01 -

Bipolar I Disorder, Single Manic Episode; Mild

296.02 -

Bipolar I Disorder, Single Manic Episode; Moderate

296.03 -

Bipolar I Disorder, Single Manic Episode; Severe, without Mention of Psychotic Behavior

296.04 -

Bipolar I Disorder, Single Manic Episode; Severe, Specified as with Psychotic Behavior

Related Terms

Manic Disorder

Overview

Bipolar affective disorder is a mood disorder that also affects cognition and behavior and may be complicated by psychotic symptoms (e.g., delusions, hallucinations, disorganized thinking). As many as two-thirds of bipolar patients have a lifetime history of psychosis (Rivas-Vasquez). Bipolar affective disorder, single manic episode is a subcategory of the disorder characterized by the occurrence of a single manic episode and no past major depressive episodes.

A manic episode is characterized by an elevated or euphoric mood and inflated self-image. The episode usually has a rapid onset, building suddenly over a few days and lasting at least a week and up to several months. The individual is filled with ideas and overflowing with energy. Behavior is dramatic, expansive, and usually overactive and may also be impulsive, intruding on other individuals or alienating friends, family, and coworkers. The individual may even become hostile if opposed. Because the individual has an inflated sense of self-worth (grandiosity), there is lack of insight into how harmful the mania is to relationships. Mood can be unstable or irritable and may be experienced as unpleasant. Mania may be associated with psychotic features such as hallucinations (false perceptions), or delusions (false beliefs). Usually the psychotic features are in keeping with the individual's sense of extraordinary well-being.

This diagnosis is not considered if the symptoms of mania accompany a medical disorder such as hyperthyroidism, use of a prescription antidepressant, or drug abuse. Initial manic episodes can occur in individuals abstaining from alcohol after years of abuse.

Incidence and Prevalence: The overall prevalence of bipolar disorder is 1% to 1.6% in both women and men (Soreff).

Diagnosis

History: History reveals only one manic episode without any prior major depressive episodes, and is associated with a persistently elevated or irritable mood for at least a week. Diagnosing a manic episode includes eliciting a history of the patient's behavior immediately before the evaluation. During the episode, the individual will exhibit at least three of the following symptoms: inflated opinion of self (grandiosity), needing drastically less sleep than normal, excessive talking, racing thoughts, distractibility, increased goal-directed activity, and indulging excessively in pleasurable activities that can result in undesirable consequences such as buying sprees or sexual binges. The manic episode leads to a marked impairment of relationships or work performance, may also endanger the individual or others, and often requires hospitalization to protect the individual.

Physical exam: The exam does not contribute to making this diagnosis. Observation of the individual's orientation, dress, mannerisms, behavior, and content of speech provide essential signs to diagnose the illness. Like other mental illnesses, bipolar affective disorder cannot yet be identified physiologically. The diagnosis is made on the basis of symptoms, course of illness, family history (when available), and use of the diagnostic criteria for manic episode found in the DSM-IV (Diagnostic and Statistical Manual of Mental Disorders, 4th Edition).

Treatment

Psychiatric hospitalization may be required during a manic episode to stabilize medication and maintain the individual's safety. Lithium or valproic acid are usually first-line treatments for acute mania, followed by carbamazapine. Newer anticonvulsants such as lamotrignine are also considered as a treatment option. In addition, antipsychotic medications such as olanzapine and clozapine may be used in cases with partial or non-response. Recently the FDA has approved risperidone, quetiapine, and ziprasidone as primary as well adjunct therapies for the treatment of mania associated with bipolar affective disorder. As response may take a week or more, major or minor tranquilizers may be added (Ferri; Rivas-Vazquez).

Psycho-educational classes, support groups, and cognitive behavioral therapy groups lend themselves well to adjunctive treatment of bipolar disorder, and spouse and family involvement can also be helpful. Integrated dual diagnosis treatment for individuals suffering from coexisting mental illness and substance addiction helps to comprehensively address both disorders at once. Electroconvulsive therapy (ECT) is rarely used for acute mania.

Prognosis

Most manic episodes persist for a week to several months and resolve without medical intervention. Most individuals will have recurrences of manic episodes. Classical bipolar affective disorder may emerge at a later time. Individuals who have their first manic episode younger than 21 are less likely to have a complete remission and are more likely to develop bipolar affective disorder and substance abuse. After a single manic episode, sexual activity will more likely return to normal, but the individual may still have difficulties in the area of recreational enjoyment.

Specialists

Comorbid Conditions

Complications

Complications may include accidental death or injury due to impaired judgment, divorce or other ruined relationships, exposure to sexually transmitted diseases because of promiscuity, financial ruin, drug or alcohol abuse, exhaustion, and disregard for self-care and nutrition.

Factors Influencing Duration

Ability to Work (Return to Work Considerations)

Impairments in judgment and disruptive behavior generally prevent employment during a manic episode. After successful treatment, closer supervision of the individual's work may be useful particularly if safety issues are involved. Night shift or rotating shifts may increase the severity of this illness.

Failure to Recover

If an individual fails to recover within the expected maximum duration period, the reader may wish to consider the following questions to better understand the specifics of an individual's medical case.

Regarding diagnosis:

Did individual exhibit signs of a manic episode?

Was diagnosis confirmed?

Were other conditions with similar symptoms ruled out?

Based on the criteria that only one manic episode was experienced with no past major depressive episodes, was the diagnosis of bipolar affective disorder with single manic episode confirmed?

Regarding treatment:

During the acute manic episode, was psychiatric hospitalization required to stabilize medication and maintain individual's safety?

Is self-harm or personal neglect putting individual at risk?

What medications were included in the drug therapy?

Is individual taking medication as prescribed?

If individual is not taking lithium or valproic acid because of side effects, could alternate medication be used instead? Carbamazepine? Lamotrignine?

Is illness interfering with self-esteem, friendships, social supports, and career goal achievements?

Would individual benefit from one-on-one psychotherapy based on interpersonal, cognitive, or behavioral approaches?

Is individual involved in a support group?

Is individual a candidate for integrated dual diagnosis treatment?

Regarding prognosis:

Is individual younger than age 21 and thus less likely to have a complete remission while more likely to develop bipolar affective disorder and substance abuse?

If symptoms have not completely resolved, is additional or extended therapy warranted?

Does individual display any tendency toward self-harm or suicide? What preventive safeguards are in place?

During the manic episode, did complications occur such as those due to impaired judgment that could impact recovery?

Is an underlying personality disorder or other psychiatric condition impacting recovery?

Does individual have a functional support system in place?

Would group therapy be beneficial in helping individual and family understand the illness and better cope with it?

Would individual and family benefit from enrollment in a support group?

If no improvement occurs after 6 to 8 weeks or if symptoms have worsened, is it time to try another treatment approach or another medication? Get a second opinion from another health care professional?